Pain with Squatting? Here is How to Fix It.

Pain With Squats?

Squats are a great exercise in the gym. They are a compound movement that targets every single leg muscle, your back muscles, and even your core muscles. Compound movements are great if you are someone who needs to save time and target multiple muscles with one movement in the gym. As the parent of a 3-year-old and business owner, I am all about efficiency with workouts. I want to take you through the movements of a squat, look at each joint that could be limiting you or causing pain, and discuss some specific and global fixes for these issues.

Let’s Talk About Squats, Baby

Squats are one of the most functional exercises that you will perform. We are constantly getting up and down from sitting all day, so we should probably be good at it. The basic purpose of a squat is to control the vertical movement of your pelvis. I have discussed this before, but a squat involves your pelvis going up and down, while a hinge (deadlift) involves it going side to side.

A squat (shown on the left) is a vertical movement, while a deadlift (shown on the right) involves horizontal movement.

In order to move our pelvis up and down, we need to be able to bend our legs while under a load. That load could be your bodyweight or external weight from dumbbells, a barbell, or anything else that you choose to use. While lowering down, we are asking our ankles to dorsiflex, our knees to flex, our hips to flex, and our pelvis to anteriorly and posteriorly tilt. Each of these movements require mobility in their respective joints. If there is a lack of mobility somewhere, it can cause other areas to compensate which results in pain or decreased performance. You would be amazed how many people plateau with squatting and blame it on strength when actually they need to unlock a little more mobility to handle a higher load.

When I see clients in the clinic for an assessment, I will start with global movements before looking at specific joints. I want to see you squat to determine if there are any glaring issues. After assessing the entire movement pattern, I will look at each joint with specific tests to ascertain any limitations. Since I can’t see you squat (unless you stop by Eclipse Wellness in Sterling, VA), I will outline the tests I use for each joint.

Are Your Ankles Limiting Your Squat?

It is easiest to start from the bottom when discussing the joints involved with the squat. The ankle needs to dorsiflex when squatting, which puts pressure on the joint itself, as well as the calf muscles in the back of the leg. A test that I use for dorsiflexion mobility involves standing near a wall. Keep one foot pointed towards the wall and bend your knee and ankle to try and touch your knee to the wall. Move your foot backwards as far as possible from the wall while still being able to touch it with your knee and without your heel coming off the ground. If the distance between your big toe and the wall is less than your fist, there is a problem. You should repeat this on both sides.

With this test, it is important to discover where the issue lies. If you feel limited because the back of your leg is tight, you need to stretch and foam roll your calf. If the front of your ankle is pinching or just generally tight, you need to mobilize the ankle joint. Mobilizing your ankle involves looping a sturdy band around a fixed bar, looping the band around the front of your ankle, and bending your knee to stretch your ankle while keeping the band taut. This stretches into dorsiflexion while mobilizing your ankle.

Pictured above is the dorsiflexion mobility test (far left) and examples of ankle mobilization exercises (center and right).

If your muscle or joint is limited, manual therapy (trigger point dry needling, massage, stretching, joint mobilizations) can be very helpful. If you are on your own, use the techniques I mentioned in the paragraph above. Despite your ankle limitations, you should keep squatting. The answer is never to fully stop the exercise. It will take a while for your ankle to gain mobility and waiting weeks to squat again is a terrible idea. Instead, try squatting with your heels elevated. You can use small weight plates or anything else to provide a slight elevation for your heels. This takes the ankles through an easier range of motion while allowing you to maintain your strength and mobility.

Are Your Knees Limiting Your Squat?

Let’s say that your ankles look great and you want to move up the chain. Next stop: the knees. Squatting requires your knees to bend. If your knees are unable to bend to the degree that you want to squat, then we have the issue. I am assuming that you are able to stretch your knee to the angle that you need for squatting, so I want to highlight something important: you need to flex your knee with load.

If you have worked out with a trainer or anyone else in your lifetime, there is a good chance that you were told to squat from your heels. This often comes from a misguided attempt to minimize stress on the knees by not letting them go over your toes. This limits your ability to load your squat as well as achieve maximal depth. If you keep your knees behind your toes, you can only squat a limited depth before you start hinging. Think of your body as a lever that is anchored at your feet. The lower your squat, the more your backside goes behind you with weight. There needs to be a counterbalance in front of your foot to stop you from falling backwards. That is meant to be your knees and your quadriceps holding you upright. If you do not train to handle load with a flexed knee, you will struggle with squatting.

The first step to fixing this issue is to shift weight to the middle of your foot and stop worrying about your knees going forward. You can play around with movements including lunges with your knees going over your toes, which are a simple way to load the movement on each side.

Example of a knees-over-toes lunge.

You can gradually load this movement and further your range of motion. If you want to keep squatting while working on this mobility (highly recommended), you can try box squats. Having something behind you will allow you to determine what depth is comfortable for you and your knee mobility. You can gradually lower the box or bench that you are using to promote more knee mobility before removing it entirely.

Are Your Hips Limiting Your Squat?

Your hips are very important when it comes to squatting. They primarily provide flexion, but your hips also need to rotate to allow for full depth with squatting. You should be able to lie on your back and comfortably pull your knee to your chest. If you get close to your chest, you are probably fine for squatting. Big limitations in this movement should be addressed with knees to chest stretches, and possible foam rolling of the glutes. Hip rotation is a little tricker to measure. The easiest way is to sit with your legs dangling over the edge of your bed, a table, or any other structure where you can relax.

From this position, rotate your foot towards the middle to measure your external rotation and towards the outside to measure internal rotation. For external rotation, I would ideally want 60 degrees and for internal rotation 40 degrees. You or someone else can eyeball this amount, or you can use the level feature on your phone. If you level your phone on the top of your knee, you can measure how much it rotates. It is easier to have someone hold your phone parallel to your lower leg if someone is available to help you.

If your hip rotation is limited, you can try a pigeon stretch for external rotation of a 90-90 stretch to target internal and external rotation. Internal rotation can be tricky to improve, but an offset dumbbell or kettlebell deadlift can help. Put the limited leg in front with 90% of your weight on it. Keep the weight in the opposite hand from the front leg. Bend your front knee slightly and keep it in position. Hinge your hips by pushing your backside back and towards the side of the front leg while bringing the weight down towards your front foot. I have included pictures here but check out the YouTube video in which I covered all of this information for a better visual if you need it. 

Left: Pigeon Stretch; Center: 90-90 Stretch; Right: Offset Deadlift

If you are limited in hip mobility, a box squat is probably a good answer. Internal rotation is most important at the bottom of the squat, so stopping yourself short of going to full depth is a great way to limit internal rotation until you have improved it on your own. Flexion and external rotation are similar and can be addressed with a box squat that is gradually progressed until you return to your full range of motion.

Is Your Pelvis Limiting Your Squat?

As I mentioned in the beginning, the goal of a squat is to move your pelvis vertically. It stands to reason that your pelvis is going to be an important part of this journey. Your pelvis needs to anteriorly tilt while lowering down in your squat before switching to a posterior pelvic tilt when you run out of hip mobility at the bottom of your squat (this is known as butt wink). Pelvic tilting is completely normal and should not be demonized. Instead, we should ensure that you have adequate pelvic mobility to squat.

The simplest way to test your pelvic mobility is to stand in a slight squat with your knees bent. Try to tilt your pelvis anteriorly and posteriorly. If you feel pain or limitations, then you should probably focus on some pelvic mobility. This is best done lying on your back and practicing a pelvic tilt before transitioning to sitting and then standing. This takes gravity out of the equation and allows you to focus on mobility. Try these movements in addition to stretching of the hip muscles and your mobility should improve.

Test your pelvis mobility by looking for limitations in your posterior and anterior tilt.

If you are looking to maintain your squat while improving your pelvic mobility, there are 2 strategies. Switching to a front squat can be very helpful. This limits the need to anterior tilt because of the redistribution of the weight to the front of your body. If you feel low back or pelvic stiffness with squatting, try front squatting for a bit and it should loosen you up. Similarly, elevating your heels can shift the weight forward slightly, which takes away a lot of stress on your pelvis. Try these two strategies to keep squatting while you improve your pelvic mobility.

How to Get Rid of Pain When Squatting

The best way to get rid of pain with squatting is to undergo an individual assessment. This should involve looking at your squat form while also assessing each individual segment of your lower body. I have outlined the basic tests and exercises that I use with my clients, but there is much more that can be done. I did not even touch on the importance of good form with squatting. There is no such thing as perfect form, but I have seen many clients whose pain with squatting went away when they were given a few tips on techniques. Seeking out an individual with a personal training or coaching background and certification (like a CSCS) is important.

If you do not have someone near you, you can use the advice that I gave above and check out the YouTube video that we posted for some options. Let me know if you have any questions and happy squatting!